Health-Insurance Exchanges Are Falling Behind Schedule
Here is an article published recently in the Wall Street Journal that cites areas of concern for those of us who support the Affordable Care Act.
By LOUISE RADNOFSKY and SARAH E. NEEDLEMAN
Government officials have missed several deadlines in setting up new health-insurance exchanges for small businesses and consumers—a key part of the federal health overhaul—and there is a risk they won’t be ready to open on time in October, Congress’s watchdog arm said.
The Government Accountability Office said federal and state health officials still have major work to complete, offering its most cautious comments to date about the Obama administration’s ability to bring the centerpiece of its signature law to fruition.
“Whether [the government’s] contingency planning will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined,” said the GAO in twin reports to be released Wednesday.
The 2010 Affordable Care Act created two exchanges, seeking to provide coverage for many Americans who now go without health insurance. President Barack Obama has said the exchanges will be ready on schedule in October, offering coverage to take effect Jan. 1, 2014, but he has cautioned that “glitches and bumps” are likely.
Around two million people are projected to receive insurance through the small business exchanges and seven million people will be enrolling in the individual insurance exchanges in 2014, according to the Congressional Budget Office.
The small-business exchanges in particular have had some early setbacks. The federal government said in April that contrary to initial plans, it wouldn’t allow workers in the first year to choose between a range of insurance options offered through employers. For the first year, companies will select one plan to offer to workers.
In some states, only one insurance carrier has expressed interest in the small-business exchange. In Washington state, officials have had to postpone the exchange altogether because they couldn’t find a carrier willing to offer small-business plans for all parts of the state.
Seventeen states are running their own small-business exchanges, with the federal Centers for Medicare and Medicaid Services carrying out the task on behalf of the remaining 33 states.
The GAO report on the small-business exchanges said officials still have big tasks to complete including reviewing plans that will be sold and training and certifying consumer aides who can help companies and individuals find plans.
It said that the 17 states running their own exchanges were late on an average of 44% of key activities that were originally scheduled to be completed by the end of March. “While interim deadlines missed thus far may not impact the establishment of exchanges, any additional missed deadlines closer to the start of enrollment could do so,” the report said.
The Obama administration has long said that it expects to be ready on Oct. 1. “We have already met key milestones and are on track to open the marketplace on time,” said Joanne Peters, a spokeswoman for the Department of Health and Human Services.
“This GAO report confirms our suspicions about the implementation of the health care law,” said Rep. Sam Graves (R., Mo.), chairman of the House Committee on Small Business. “With each passing day it appears the creation of the exchanges are very much in doubt.”
The administration has welcomed signs that the growth of health-care costs has tempered recently. Some economists believe that may be partly due to the new health law encouraging more cost-effective care. The Labor Department said Tuesday that its price index for medical care fell a seasonally adjusted 0.1% in May, the first monthly drop in almost four decades.
The administration and liberal groups are stepping up efforts to prepare people to enroll for coverage. For the economics of the exchanges to work, they must attract healthy people to balance the risk of those who have chronic diseases.
Enroll America, an administration-backed nonprofit group, opened its “Get Covered America” campaign Tuesday. “We are at a place where…78% of the uninsured aren’t even aware of what’s coming their way,” said Anne Filipic, the group’s president.
Republicans who oppose the health-care law are poised to highlight any glitches in the rollout, and many believe implementation of the law could be a key issue in 2014 elections.
Regulators in New Hampshire have said they received applications from only one carrier, Anthem Blue Cross and Blue Shield, a unit of WellPoint Inc., WLP +0.36% to sell small group plans or individual policies through the exchange next year.
Small-business owner Nancy Clark of North Conway, N.H., said she was disappointed more carriers didn’t apply because Anthem is already one of just two carriers that doctors in her area accept.
“I was hoping more [insurance] providers would step up to the table,” said Ms. Clark, whose firm, advertising agency Glen Group Inc., has 10 employees and has offered benefits to full-time staff since 1997 to attract and retain talented workers. “I had these rose-colored glasses on, thinking that doctors in our area would then accept more insurance plans, truly giving everyone a choice.”
Ms. Clark said she also worried that without more carriers in the exchange, the cost of a group health plan wouldn’t stabilize or go down as she had anticipated. She said her premiums have increased every year by double digits despite her work force’s good health.
Some Democratic members of Congress also are beginning to express concerns about particular aspects of the law relating to employers. Sen. Joe Donnelly of Indiana, who voted for the law as a member of the House, on Wednesday is expected to become the first Democrat who backed the law to support changing a requirement that larger firms must provide coverage to employees working 30 hours a week or more, his staff said.
Joe Trauger, vice president of human resources policy for the National Association of Manufacturers in Washington, D.C., said the trade group’s 12,000 members are “deeply concerned” about the lack of information available about the state exchanges. “It comes up in every meeting I’m in,” he said.
Backers of the law say that over time, competition between carriers and new restrictions barring insurers from setting small group premiums based on members’ medical history will keep costs in check for business owners and enable them to keep offering coverage.
Michael Brey, president of Brey Corp., a toy retailer in Laurel, Md., that does business as Hobby Works, said he was looking forward to being able to shop for a small-group plan from a variety of carriers through his state’s exchange. Currently he can choose from just three carriers. “I have some degree of confidence that it will be a good move for us,” he said.
Mr. Brey also said he expected to get a better deal through the exchanges. He covered 100% of the cost of premiums for his staff when he bought the business in 1992, but he said he can only afford to contribute 50% now, and only for full-time employees.
—Jennifer Corbett Dooren contributed to this article.
Write to Louise Radnofsky at firstname.lastname@example.org and Sarah E. Needleman at email@example.com
- Published in Affordable Care Act, Colorado State Initiatives, Federal Law Changes and Mandates, Individual Health Insurance
Who are the Health Uninsured In Colorado?
Well, according to Westley Mori, Research Analyst for the Colorado Health Institute, they are low income adults. Here are some of the findings from his work:
About one in five Colorado adults between the ages of 19 and 64 did not have health insurance in 2010. Adults represent the vast majority—about 83 percent—of Colorado’s uninsured.
Digging deeper, CHI finds wide variation within that group of uninsured adults. Findings in “Health Insurance Status of Colorado Adults” include:
•About 640,000 adults were uninsured in 2010, up from about 623,000 in 2008.
•The uninsured rate for adults varies dramatically by region – from a low of seven percent in Douglas County to a high of 27 percent in Adams County.
•Forty percent of the uninsured adults have annual incomes below 133 percent of the federal poverty level (FPL), or about $29,000 for a family of four.
•Sixty-three percent of uninsured adults are employed.
Adults without dependent children (AwDCs) with incomes at or below the FPL, about $11,000 for an individual, have an uninsured rate of 41 percent, twice that of the average adult in the state. Within this group, CHI estimates that:
•Six in 10 (about 94,000) are male. In comparison, about 50 percent of Colorado’s adult population is male.
•The vast majority are single.
•More than a third are employed, either full- or part-time.
In my opinion, the Affordable Care Act requirement that all citizens have health insurance, that goes into effect January 1, 2014, will do little to change these numbers. Coverage will still be expensive, rebates using the tax system will be complicated and not timely and the penalties for non-compliance will be low in the begining.
We will see what we will see.
- Published in Individual Health Insurance, Personal Observation
Colorado Continuation/Conversion is a state law that assures an employee who leaves a company with less than 20 full time employees and has been covered by the firm’s health insurance plan for 6 continuous months, a continuation of their health insurance coverage for up to 18 months, except in cases of “gross misconduct.” For an employee leaving a Colorado based company with more than 20 employees, the federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) applies.
The ex-employee will be responsible for the full premium (the combination of that which the employer and the employee were previously paying) plus a small administrative cost.
Within 10 days of termination, the employer must sent written notice to the employee of the right to continue. The employee then has an “Election Period” of 30 days from termination to notify the employer of acceptance.
If after this period the employee decides they do not want to accept Continuation coverage, they owe nothing. However, if they do decide they want to accept the coverage, they will owe premium back to their last day of employment.
One concern with smaller companies is that if the firm goes out of business and/or cancels their health insurance plan, this whole option disappears for the ex-employee.
Colorado Continuation/Conversion is a form of “group health insurance” and generally cannot exclude coverage for pre-existing conditions. However, because of this, the premiums are much higher than a relatively healthy person or family could obtain with an individual policy.
If you would like to know more about your options, please give me a call at 303-541-9533.
- Published in Colorado State Initiatives, Individual Health Insurance, Misc
On Line Health Insurance Quotes
If your in-box is anything like mine, you are receiving an endless stream of offers for on-line health insurance quotes. If you are perfectly healthy and know enough about health insurance to be able to select a plan that is well suited for your situation, then this system will work well for you.
However, if you are dealing with some, even minor, pre-existing conditions, or you have not been keeping up on all the changes in the health insurance industry, it might behoove you to speak to an experienced health insurance broker like, modestly, me.
Pre-existing conditions? I promise you that different health insurance companies look very differently at certain pre-existing conditions like; depression, asthma, recent operations, gout, build (height vs. weight), DUI’s and many others. An experienced broker can steer you towards the company who will give your application the best chance of being accepted.
The “right” plan? Low priced health insurance plans often have hidden “gotchas.” These might include excessive co-insurance charges, limited or no doctors’ office visits, no “branded” prescription coverage, additional “access fees” for hospital/ER visits, no mental health coverage, etc. Unless you know what you are doing or have someone to point these “holes in coverage” out to you, you may end up buying a policy that excludes the very things you most want covered.
And, best of all, it costs you nothing to work with a broker; the insurance companies pay our commissions. The cost to you is the same either way.
So, give me a call at 303-541-9533, if you want to make sure you are getting the health insurance coverage you are paying for.
- Published in Applications, Individual Health Insurance, Premiums, Underwriting
Use of Tobacco Greatly Increases Health Insurance Premiums
If the health risks associated with the use of tobacco are not enough to get a person to consider stopping, perhaps the monetary penalties will tip the scale. Not only does a tobacco consumer (cigarettes, cigars, pipe, chew, dip, etc.) have to pay for the cost of the product and all the punitive taxes attached to it, but their premiums are significantly “rated-up” when they apply for health insurance.
Because the actuaries that work for health insurance companies well understand that tobacco users are much more likely to require expensive medical treatments than non-users, smokers/chewers are charged more for coverage. Typically a 25 year old tobacco user pays 20% more and at 50 it can be 30% or higher.
In order to qualify as a non-tobacco user you must have gone the previous 12 months without its use. You will also want to be truthful about tobacco use on a health insurance application, because if you are not, your policy may be cancelled just when you need it.
If you are presently insured with a plan that rates you as tobacco user, you can request that this be changed once you have abstained from its use for a minimum of 12 months. You will probably be asked to submit a blood test to prove you have no nicotine in your system.
So, the choice is quit or pay up.
If you’d like to know more about this, please give me a call at 303-541-9533.
- Published in Individual Health Insurance, Underwriting
Meeting with Clients
I meet in person with the vast majority of my clients, most often in my home-office, but occasionally in their homes as well.
Most health insurance agents never see their clients in person, but rather deal with them over the internet or on the telephone. This has never worked for me for a number of reasons.
* There are some complex concepts involved with health insurance and I have found it difficult making them understood when I am not physically with a person.
* I find most clients prefer having an in-person relationship with their agent; it is a matter of building trust.
* The part about my job that I enjoy most is meeting with clients. One certainly gets to know someone quickly when you are talking about their health insurance.
* Since I am a poor typist, and anything to do with health insurance involves filling out forms, I am able to enter the information by hand on forms when the client is sitting right their next to me.
I am fortunate that my home-office is located in an easy-to-get-to location in downtown Boulder.
Additionally, working with clients out of my home gives me an additional incentive to do a good job for them, THEY ALL KNOW WHERE I LIVE.
- Published in Applications, Individual Health Insurance
Filling Out Individual Health Insurance Applications
Most clients originally call me to help them sort through their options for health insurance and come up with some recommendation for the best combination of price and value for them.
However, once this is done, I believe the greatest service I can provide is to help a client fill out an application. It can save you a lot of brain damage. Each year these forms carry more and more obscure legal clauses and terminology, supposedly included to protect the consumer, but mostly it just confuses everyone.
Here are a couple of examples from Anthem and United Healthcare.
The parts of an application that many people stumble on are the federally mandated form:
THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPPA)
and the State of Colorado required:
DETERMINATION OF SELF-EMPLOYED BUSINESS GROUP OF ONE.
In ten years of doing this, with thousands of applications filled out, not once did these parts of an application help a single person obtain health insurance, but the confusing nature of the questions surely have stopped many of them from finishing the paperwork.
These requirements are prime examples of your government creating road blocks to something that could be easily achieved, all in name of “protecting you from yourself.”
If you need new health insurance and want to avoid the agony or filling out the forms yourself, give me a call at 303-541-9533. It costs no more to work with a broker and, as I said, it saves a lot of brain damage.
- Published in Applications, Individual Health Insurance